COUNSELING BOOSTS
IMMUNITY, IMPROVES HEALTH HABITS

COLUMBUS, Ohio – Regular psychological counseling for breast cancer
patients may do more than just lower their stress and anxiety. A new study
says the right kind of intervention can also mean healthier diets, reduced
smoking, and most surprising of all – a stronger immune system.

Barbara
Andersen

The findings, published in the Sept.1 issue of the Journal
of Clinical Oncology, are the first to come from a long-term
study at the Ohio State University Comprehensive
Cancer Center (OSUCCC) of the impact of stress on immunity among breast
cancer patients. They also add more evidence to one side of a longstanding
debate over the value of psychological intervention in cancer treatment.

“We were so surprised with the findings about immunity that we
repeated the tests over and over again as more patients entered the trial,”
says Barbara Andersen, a professor of psychology
at Ohio State University and lead investigator in the study.

"Ours is the first
study to use an experimental design to discover what, if any, relationship
exists between psychological intervention and risk of recurrence.
Statistically, we just don’t have enough data yet to determine
that, but so far, we know that the intervention is beneficial and
the findings are robust."

Ten years ago, Andersen and her colleagues at Ohio State began studying
women with stage II or stage III breast cancer to find out if reducing
stress and changing health habits have any impact on the incidence and
timing of recurrence. While it is too soon to answer that question, researchers
say interim data clearly show that the intervention itself offers powerful
psychological, behavioral and biological benefits for patients.

Two hundred and twenty-seven women enrolled in the study after surgery
but before continuing additional treatment with chemotherapy or radiation.
They were randomized to one of two groups – one that received psychological
intervention and one that received only a psychological assessment. All
participants completed interviews and questionnaires designed to measure
emotional distress, social adjustment and health behaviors. Researchers
also took blood samples for immunity studies.

Patients in the intervention group met weekly in small-group sessions
to learn ways to lower their stress, improve their mood, modify key health
behaviors and follow their treatment plans. Researchers used the same
interview process and questionnaires to reassess them four months later
at the end of the intervention period.

Women in the assessment-only group received no psychological intervention,
but they were also reevaluated at the end of the four-month period using
identical measures.

As expected, the intervention helped patients in the treatment group.
Overall, they reported lower stress and improved mood and said they felt
they were getting more support from friends and family, compared to those
who were only assessed. In addition, a significant number of patients
in the intervention group developed healthier eating habits and quit smoking,
while women in the assessment-only group made no significant changes in
their diets and actually increased their cigarette use.

Researchers also examined two key markers of the patients’ immune
systems, the activity of natural killer (NK) cells and the capacity of
certain T-cells to grow and multiply. T-cells and NK cells are critical
to the body’s immune system – they help identify and destroy
infectious or mutated cells that might lead to cancer and other diseases.

In assessing the strength of the patients’ immune systems, scientists
measured the numbers of T-cells and certain T-cell subsets (CD3, CD4 and
CD8) in both groups. They also evaluated the ability of the T-cells to
grow and multiply.

After controlling for all other variables, researchers found no significant
change in the numbers of T-cell or NK cells present. They discovered,
however, that women in the intervention group showed a stable or improved
T-cell proliferative capacity.

On the other hand, women in the assessment-only group had decreased T-cell
proliferative capacity across all measures.

“These findings are important because there has only been one
other study linking stress reduction and changes in immunity. It found
no changes in the immune system at the end of the intervention, but it
did find changes six months later. Given the strength of our results and
the fact that are consistent with other improvements, we simply have to
do more to fully understand what is going on.”

Carson, who is also associate director for clinical research and co-leader
of the Immunology Program at the OSUCCC and a surgeon at the Arthur J.
James Cancer Hospital and Richard J. Solove Research Institute, notes
that some types of cancers appear to stimulate the immune system more
than others – a phenomenon known as “immunogenicity.”
He adds that breast cancer is only moderately immunogenic, suggesting
an immune response to the psychological intervention might be even more
pronounced when tested in other malignancies, like renal cell carcinoma
or basal cell carcinoma.

“Our findings spark more questions than answers, at this point,”
he says.

Andersen’s research team is already compiling patient data from
one and two years into the study and says early indications suggest these
early findings will remain consistent over time.

“Ours is the first study to use an experimental design to discover
what, if any, relationship exists between psychological intervention and
risk of recurrence. Statistically, we just don’t have enough data
yet to determine that, but so far, we know that the intervention is beneficial
and the findings are robust, and that gives us greater confidence we have
a strong test regarding impact on recurrence,” says Andersen.

The study is funded by grants from the General Clinical Research Center
at Ohio State, the National Cancer Institute,
the National Institute of Mental Health,
U.S. Army Medical Research Acquisition Activity Grant, the Longaberger
Company-American Cancer Society Grant for Breast Cancer Research and the
American Cancer Society.